Provider Demographics
NPI:1437357951
Name:LEVINE, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:LEVINE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3835 N FREEWAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1928
Mailing Address - Country:US
Mailing Address - Phone:916-576-7898
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:3835 N FREEWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1928
Practice Address - Country:US
Practice Address - Phone:916-576-7898
Practice Address - Fax:916-285-0338
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2017-05-08
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Provider Licenses
StateLicense IDTaxonomies
CAG343332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGN368ZMedicare PIN